A 24-year-old woman came with complaints of upper abdominal swelling for the last 6 months, early satiety associated with loss of appetite and weight for 3 months, abdominal pain for the last 1 month, and vomiting for the last 4 days. Abdominal examination revealed a centrally placed solid swelling in the epigastric region with mild tenderness. Abdominal ultrasound and contrast-enhanced computed tomography (CECT) abdomen showed multiple liver secondaries and diffuse circumferential gastric wall thickening and enlarged peripancreatic and periportal nodes [Figure 1]. Ultrasound of neck and Doppler and CECT neck showed partial thrombus in the left internal jugular vein thrombosis (IJVT) proximal to its origin for a length of about 1.7 cm [Figure 2]a and [Figure 2]b. Upper gastrointestinal scopy showed ulceroproliferative growth in the body, antrum, and pylorus region with features of infiltrating adenocarcinoma of poorly differentiated diffuse type on biopsy.

Gastric carcinoma is the second most common cause of cancer-related death worldwide.[1] Advanced gastric carcinoma commonly presents with outlet obstruction, dyspeptic symptoms, and features of metastasis with IJVT being an uncommon presentation.[2]

Trousseau first reported the migratory thrombophlebitis associated with gastric carcinoma.[3] Virchow suggested that hypercoagulability due to stasis, tumor cell activation, and vessel wall injury are responsible for thrombosis in patients with malignancy.[2] Deep vein thrombosis commonly affects the lower limbs. Head and neck veins are less prone to thrombosis as they are usually valve-less and gravity-prone.[4] Venous thrombosis can have serious life-threatening complications like chylothorax, airway edema, systemic sepsis, and pulmonary embolism.[5] Doppler ultrasonography is an excellent diagnostic method for IJVT with sensitivity of 97% but has limits in the subclavian vein and superior vena cava evaluation where CECT and magnetic resonance imaging are helpful.[4],[6] Zyrianov et al.[7] in their study of 108 patients with gastric carcinoma found that deep venous thrombosis of the lower limbs was seen in 37% of the cases. However, literature correlating with IJVT and stomach cancer is limited.[2],[8] In this patient, left IJVT was found during evaluation for Virchow's nodes. Thrombosis may present with or without thrombus-related symptoms as seen in our case. Anticoagulation is the main treatment of choice for venous thrombosis. Heparinization is used widely, followed by anticoagulation with warfarin. Anticoagulation could prevent complications from thrombosis such as septic embolism and pulmonary embolism.[8] As pulmonary embolism is a life-threatening complication of jugular venous thrombosis, it is important to be aware of the thrombotic tendency in patients with gastric malignancy.

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